Bendamustine combined regimen for Hodgkin's lymphoma

www.thelancet.com/oncology Vol 17 August 2016 e326 Bendamustine combined with gemcitabine plus vinorelbine induces a complete response in a high proportion of patients with Hodgkin’s lymphoma, suggests fi ndings from a new study by Armando Santoro (Humanitas Cancer Center, Milan, Italy) and colleagues. The combination treatment was an induction chemotherapy salvage regimen given to patients who had relapsed after, or were refractory to, one previous line of chemotherapy, before autologous stem-cell transplantation. For this multicentre, phase 2 singlearm study, 59 patients (median age 33 years [range 18–68]) were given four cycles every 21 days of gemcitabine 800 mg/m2 on days 1 and 4, vinorelbine 20 mg/m2 on day 1, and bendamustine 90 mg/m2 on days 2 and 3. 43 (73%) of 59 patients achieved a complete response (the primary endpoint), and six (10%) achieved a partial response. One patient (2%) had stable disease and eight (14%) had progressive disease. After a median follow-up of 29·1 months (range 3·4–49·1), around 37 (62%) achieved 2-year progression-free survival and 46 (78%) achieved 2-year overall survival. The most common adverse events were grade 1 and 2 nausea (10 [17%] patients) and infection (9 [15%]), and grade 3 and 4 neutropenia (8 [14%]), and thrombocytopenia (8 [14%]). Of the 49 responders, 43 (73%) went on to receive autologous stem-cell transplantation. Santoro remarked “Achieving a complete response after induction chemotherapy before autologous stem-cell transplantation in patients with refractory or relapsing Hodgkin’s lymphoma represents the strongest prognostic factor for outcome. The bendamustine–gemcitabine–vinorelbine regimen seems the most effective treatment for such patients, and should be considered the standard of care. Future trials should assess whether combining this regimen with PD-1 or PDL-1 checkpoint inhibitors could further improve the cure rate.” Bertrand Coiffi er (Centre Hospitalier Lyon Sud, Pierre Benite, France) said “For relapsed or refractory disease, autologous transplantation is associated with a good outcome if the salvage regimen induces a complete response or near-complete response before transplantation. The results from Santoro and colleagues are quite good, even if the follow-up was short and there was probably some bias in the accrual—as in any phase 2.” Coiffi er added that, “These [results] need to be confi rmed in a larger study but this regimen might become the standard for patients with relapsed or refractory Hodgkin’s lymphoma.”